RALEIGH, N.C. (WNCN) – After years of opposition, Republicans in the state Senate are finalizing details of a bill to expand Medicaid coverage in North Carolina and could file the bill as soon as this week. 

It’s a step Gov. Roy Cooper (D) has asked them to take since before he took office and was a primary issue behind a standoff over the state budget that lasted more than two years

According to a draft of the bill obtained by CBS 17, it would expand coverage to about 600,000 people in the state. North Carolina is among 12 states in the country that has not expanded Medicaid as part of the Affordable Care Act.  

“No bill expanding Medicaid has been filed. Senate Republicans continue to have discussions about how to address the rising costs of healthcare and how to increase access in the state,” said Lauren Horsch, a spokesperson for Republican Senate leader Phil Berger. 

Gov. Cooper has repeatedly called for the legislature to expand Medicaid, citing the potential economic benefits, greater access to healthcare for those who are struggling to afford it and the help it could provide struggling rural hospitals. 

He signed a budget into law late last year that did not expand Medicaid, but it did establish a legislative committee that’s been closely studying the issue for the last several months.  

“And, I believe we’re getting closer than ever to an agreement,” Cooper said at a press conference earlier this month in which he called once again for state lawmakers to expand Medicaid during the current legislative session. 

State Sen. Wiley Nickel (D-Wake) called the draft Senate proposal an “important first step.” 

“The data is overwhelming. We can see that it’s going to bring down healthcare costs. We can see that it’s going to keep rural hospitals from closing. We know that. We have red states all over the country that have said yes to Medicaid expansion,” he said.  

The federal government pays 90 percent of the cost for states to expand Medicaid. Under the American Rescue Plan, which Democrats in Congress passed last year, they included a provision that temporarily increases the federal share to 95 percent in an effort to entice leaders of non-expansion states like North Carolina to approve Medicaid expansion. 

Republicans note that the state would receive about $1.5 billion over two years for expanding Medicaid. 

“Now that we’ve seen how well this has worked in so many places, we’ve seen what’s worked well, what hasn’t worked as well. North Carolina can move forward with a solution that makes the most sense for us,” said Erica Palmer Smith, executive director of Care4Carolina, which advocates to close the health coverage gap. “We’ve had this opportunity to learn from other states how to do this the best way. And so, I think our legislators are prepared to put together a plan that does this the best way for our state.” 

The bill draft shows Republicans also are including a work requirement with certain exceptions, such as people with disabilities that impair them from performing “one or more activities of daily living” and parents with a child under one year of age. 

The Biden administration opposes Medicaid work requirements and has been withdrawing approvals that the Trump administration had granted to states.  

The bill Senate Republicans will file calls for a hospital assessment to pay the state’s share of the cost. The state Dept. of Health and Human Services is also required to submit an annual report accounting for all revenue to pay the state share. If those revenues are insufficient, then people’s coverage would be “discontinued as expeditiously as possible.”  

Republicans also have included a variety of other changes dealing with access to healthcare in the bill that go beyond Medicaid expansion including: provisions to address surprise medical billing and transparency, giving nurses greater ability to practice outside the supervision of a physician, certificate of need law reforms and telehealth regulations. 

Jordan Roberts, director of government affairs at the conservative John Locke Foundation, said his group supports many of those other provisions but remains opposed to Medicaid expansion. 

“It’s unfortunate that we’ve gotten to a point where there’s a lot of people who can’t afford insurance. But, we think Medicaid needs to stay for the populations that it was originally designed for,” he said. “Adding able-bodied adults without children to that program is bad healthcare policy and it fails to address the root problems.” 

Republican leaders in the House recently have been resistant to expanding Medicaid, so it’s unclear whether the bill actually would pass during the current legislative session. 

Last week, Republican House Speaker Tim Moore said he “would be surprised” if it did. 

On Monday after details of the proposed bill were published, Demi Dowdy, a spokesperson for Moore said, “We have been clear with the Governor and our Senate counterparts that Medicaid expansion will only move forward in the House if there are sufficient votes for a bill. Many of our members are concerned about a massive expansion of an entitlement program during record inflation and economic uncertainty. Attaching controversial, unrelated topics to expansion does not help the bill’s prospects for this short session.”